Provider Demographics
NPI:1073114609
Name:GRACE PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:GRACE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-683-8081
Mailing Address - Street 1:2218 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5423
Mailing Address - Country:US
Mailing Address - Phone:401-206-5685
Mailing Address - Fax:469-281-0484
Practice Address - Street 1:2218 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5423
Practice Address - Country:US
Practice Address - Phone:401-206-5685
Practice Address - Fax:469-281-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy